Summary
Overview
Work History
Education
Skills
Languages
Websites
References
Timeline
Generic

Karen Orozco

Kyle,TX

Summary

Dynamic professional excelling in data analysis and process improvement. Adept at fostering relationships and enhancing operational efficiency, I leverage strong problem-solving skills to drive impactful results. Committed to delivering exceptional client support while managing complex projects and ensuring compliance with industry standards.

Overview

14
14
years of professional experience

Work History

Co-Owner

CATAS Painting LLC
Austin, TX
07.2021 - Current
  • Oversaw day-to-day operations, including scheduling, budgeting, and client communications.
  • Coordinated schedules and resources for multiple painting contracts.
  • Developed client relationships to understand project requirements and expectations.
  • Implemented inventory control procedures to manage supplies effectively.
  • Resolved any customer complaints or issues quickly in order to maintain positive relationships.
  • Maintained client records and project documentation, ensuring accuracy and compliance.
  • Coordinated a team of contractors to uphold quality control and timely job completion.
  • Managed financial records, processed invoices, and executed payment collections.
  • Resolved customer inquiries efficiently while fostering strong client relationships.

Business Analyst

Superior HealthPlan
Austin, TX
05.2021 - 12.2021
  • Analyzed business processes and recommended improvements to streamline workflow and reduce costs.
  • Created detailed reports and presentations for senior management, providing insights on operational performance.
  • Coordinated with various departments to ensure the accurate and timely completion of business initiatives.
  • Managed data entry, project tracking, and report generation to support business decisions.
  • Collaborated with cross-functional teams to gather and document business requirements.
  • Skills and Responsibilities.
  • Proficient in data analysis and reporting.
  • Strong problem-solving abilities, and process improvement skills.
  • Ability to communicate complex data to non-technical stakeholders.
  • High attention to detail, with a focus on operational efficiency.

Claims Liaison

Superior HealthPlan
Austin, TX
03.2018 - 03.2020
  • Served as primary contact between clients and claims department, ensuring accurate and efficient claim processing.
  • Managed claim submission process, verifying documentation and compliance with insurance guidelines.
  • Resolved escalated customer issues by addressing discrepancies in claims effectively.
  • Coordinated with internal teams to ensure timely resolution of complex claim issues.
  • Demonstrated proficiency in claims processing and customer service through consistent performance.
  • Utilized strong interpersonal communication skills to address client concerns promptly.
  • Identified and rectified discrepancies in records and claims to maintain accuracy.
  • Executed data entry and record-keeping tasks to support operational efficiency.

Grievance & Appeals Coordinator

Cenpatico
Austin, TX
10.2015 - 03.2018
  • Managed grievance and appeals processes to ensure compliance with company policies and state regulations.
  • Reviewed clinical records to ensure compliance with regulatory standards and internal policies.
  • Communicated with providers and members to gather necessary information for appeals.
  • Analyzed appeal trends to identify areas for process improvement and efficiency gains.
  • Collaborated with cross-functional teams to resolve complex appeal cases effectively.
  • Maintained accurate records of all appeal cases using internal case management systems.
  • Developed clear written communication for appeal determinations and member notifications.
  • Maintained records of all appeal activities in a timely manner.
  • Collaborated with physicians, nurses, administrators, and other staff members to resolve issues quickly and efficiently.
  • Responded promptly to all correspondence from third-party payers regarding patient claims.
  • Tracked progress of ongoing appeals cases using computer software systems.
  • Reviewed denied claims for potential resubmission or reconsideration.
  • Answered incoming calls from providers seeking assistance with appeals processing.
  • Provided support to internal personnel regarding appeals process inquiries.
  • Coordinated across departments to gather information for investigations and resolutions.
  • Prepared case summaries and communicated outcomes to clients and stakeholders.
  • Tracked grievance and appeal outcomes to meet documentation deadlines.

Claims Liaison

Cenpatico
Austin, TX
01.2015 - 10.2015
  • Coordinated claims among patients, providers, and insurance for accurate processing and timely payments.
  • Collaborated with healthcare providers to clarify claims requirements and policies.
  • Analyzed claim submissions for accuracy and compliance with company guidelines.
  • Resolved escalated claims issues through effective communication and problem-solving.
  • Developed training materials to enhance understanding of claims management systems.
  • Monitored claims inquiries, identified trends, and recommended process improvement initiatives to management.
  • Identified discrepancies between documentation submitted and actual payments made in order to prevent payment errors.
  • Participated in training sessions designed to enhance knowledge of insurance industry standards and processes.
  • Managed inquiries regarding claim statuses, benefits, and coverage options efficiently.
  • Provided clients with necessary documentation and support for claims and healthcare services.
  • Collaborated with internal departments to expedite claim resolution and ensure accuracy.

Customer Service Representative

Cenpatico
Austin, TX
08.2013 - 01.2015
  • Delivered customer support via phone and email, resolving inquiries related to healthcare services and claims.
  • Managed customer accounts and updated information in the database efficiently.
  • Documented interactions with customers accurately for record-keeping purposes.
  • Handled escalated concerns, providing effective solutions to maintain satisfaction.
  • Trained new staff on customer service protocols and company systems effectively.
  • Analyzed feedback to identify areas for improvement in service delivery processes.
  • Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
  • Remained calm and professional in stressful circumstances and effectively diffused tense situations.
  • Maintained detailed records of customer interactions, transactions and comments for future reference.
  • Resolved complex problems by working with other departments to provide solutions that meet customer needs.
  • Maintained accurate client records and updated databases for efficient request processing.
  • Coordinated scheduling of healthcare services for clients to ensure timely delivery.
  • Provided comprehensive information on claims, policies, and covered services.

Customer Service Representative

Maximus
Austin, TX
01.2012 - 08.2013
  • Delivered exceptional customer service by addressing inquiries, processing requests, and resolving complaints.
  • Managed customer accounts to ensure accuracy and resolve concerns promptly.
  • Tracked and reported customer feedback to enhance company services.
  • Utilized customer service software for efficient data entry and management.
  • Handled high volumes of customer interactions with professionalism and efficiency.
  • Demonstrated excellent communication and problem-solving skills in all engagements.
  • Adapted swiftly to dynamic environments, maintaining high performance levels.
  • Ensured comprehensive follow-up on customer issues for optimal satisfaction.

Education

High School Diploma -

Lehman High School
Kyle, TX
01.2011

Skills

  • Administrative support and organization
  • Data analysis
  • Process improvement
  • Team coordination
  • Quality control
  • Problem solving
  • Relationship building
  • Attention to detail
  • Report generation
  • Systems management
  • Problem-solving
  • Small business operations
  • Team building
  • Records management
  • Decision-making
  • Product development
  • Task delegation
  • Performance analysis
  • Clear communication
  • Project management
  • Budgeting
  • Data entry and document management
  • Client communication and support
  • Conflict resolution and relationship building
  • Claims processing and dispute resolution
  • Business analysis and operational improvement
  • Microsoft Office Suite proficiency
  • Attention to detail in documentation

Languages

English
Professional
Spanish
Professional

References

References available upon request.

Timeline

Co-Owner

CATAS Painting LLC
07.2021 - Current

Business Analyst

Superior HealthPlan
05.2021 - 12.2021

Claims Liaison

Superior HealthPlan
03.2018 - 03.2020

Grievance & Appeals Coordinator

Cenpatico
10.2015 - 03.2018

Claims Liaison

Cenpatico
01.2015 - 10.2015

Customer Service Representative

Cenpatico
08.2013 - 01.2015

Customer Service Representative

Maximus
01.2012 - 08.2013

High School Diploma -

Lehman High School

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Karen Orozco